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G. Gangwar et al.

10.1 Introduction

The global threat posed by the introduction of new microbial diseases and rising rates of antibiotic resistance persists. The diploid fungus Candida auris, which belongs to the Metschnikowiaceae family, has seven chromosomes and a genome that ranges in size from 12.1 to 12.7Mb. The WHO has classied the C. auris infec­tion, which was discovered in Japan in 2009, as urgent. Infections with C. auris are linked to signicant death rates, which can reach 30–60%. Implanted medical device, diabetes, recent surgery, and old age are risk factors that are associated with C. auris infections (Kean and Ramage 2019).
The property of C. auris to withstand multiple drugs makes it a “superbug” that
is posing a risk to human health. Two unique characteristics of C. auris are thermo­tolerance and salinity tolerance. Candida auris is a member of CTG clade, wherein CTG codes for serine rather than leucine, just like Candida albicans, Candida tropi- calis, Candida haemulonii, and Candida lusitaniae. On the basis of genomic data ve main distinct genetic clades of C. auris are known: the South Asia Clade (I), the East Asia Clade (II), the South Africa Clade (III), the South America Clade (IV), and the Iran Clade (V). Due to its ability to mimic the morphology of other closely related fungi, e.g., C. haemulonii and C. pseudohaemulonii, the identication of this fungus was critical. Mass spectrometers were used to accurately distinguish it from other fungi. Recently, a number of diagnostic techniques based on nucleic acid detection and/or plate assays have improved the accuracy of identication (Du etal. 2020).
An examination of 350 isolates from India revealed that 90% of the isolates were
insensitive to the antibiotic uconazole, 2% to the micafungin and anidulafungin (echinocandins), and 8% to amphotericin B (Kean and Ramage 2019). No hospital disinfectants as such are registered for use specically against C. auris (Cadnum etal. 2017). In Candida species, the tolerance mechanism to azole antifungal agents has been described and broadly classied into (a) alterations to the plasma mem­brane or cell wall that impair the uptake of drugs (azoles); (b) mutation in ERG11 gene; (c) the drug efux pumps of MFS and ABC family (Mishra etal. 2007). The pathogen exhibits high drug resistance in its biolm form. The Candida auris bio­lm is robust, according to CDC guidelines. C. auris biolms can endure multiple harsh environments in addition to being resistant to common disinfectants based on ammonium salts. Therefore, understanding biolm in the context of infection is crucial. The molecular underpinnings of this organism’s pathogenicity, the critical function of biolms, and its resistance to antifungals remain largely unknown, despite its extraordinary worldwide emergence.
10.2 C. auris Pathogenesis Including Planktonic
andBiofilm Cells
A fungal pathogen’s pathogenicity depends on its capacity to adapt to the stresses imposed by its host. Several important virulence factors are expressed by C. auris, including adhesins, the capacity to form biolms, and enzymes like phospholipases,
10 Dissemination ofCandida auris Biolms: AMedical Abrosia
263
proteinases, and secreted aspartic proteases. In an anaerobic environment, C. auris could not grow. A role for Hog1 stress-activated protein kinase (SAPK) in enhanc­ing stress tolerance has been observed in C. auris. C. auris is also known for its thermotolerance, which allows it to grow best at 37°C and continue to be viable at 42°C (Bidaud etal. 2018; Forsberg etal. 2019; Jackson etal. 2019). Apart from temperature, C. auris can withstand hypersaline environments, which can lead to the formation of pseudohyphae-like morphology, unlike other species of Candida (Jackson etal. 2019; Kean etal. 2020). Evidence so far suggests that C. auris does not use morphological switching, which plays a crucial aspect in C. albicans patho­genesis (Larkin etal. 2017; Day etal. 2018). Further, in response to cell cycle arrest or Hsp90 depletion, which controls antifungal resistance and virulence, Candida auris undergoes a morphogenetically alteration from yeast to lamentous form. Cell wall-related genes are impacted by global transcriptional remodelling during this developmental transition (Vila etal. 2020).
At rst, C. auris was studied for phenotype switching, it did not form hyphae or
pseudohyphae. C. auris can form basic pseudohyphae under high salt concentration (Sherry etal. 2017). Interestingly, the hyphae coding gene ECE1 and HWP1 are not present in C. auris (Munoz etal. 2018). In Candida, secreted aspartyl proteinases (SAPS) virulence factor is present which is responsible for cell-wall formation, adhesion, biolm, and host tissue degradation. SAPS also inhibit the immune com­plement system and escape the immune system (de Jong and Hagen 2019; Rapala­Kozik etal. 2018). In C. albicans SAP4, SAP5, and SAP6 are the most crucial for virulence (Lee etal. 2009). Hydrolases are the main secreted enzyme in C. auris. The orthologs of four SAPS have been observed in C. auris genome (Chatterjee etal. 2015). C. albicans SAPS was observed to be highly active at 25, 37, and 40°C (Wang etal. 2018) while C. auris SAPS at 42°C, supporting the high-temperature resistance compared to other species of Candida. Lipase is an another virulence enzyme that causes biolm formation, kills host cells, and escapes the immune system (Ghannoum 2000). In experiments involving C. parapsilosis, lipases were inhibited through knock-down methods. This resulted in the yeast strains being more readily absorbed by macrophages and less able to evade immune cells than the control strains (Gacser etal. 2007). Phospholipases secretion is strain dependent which helps in biolm formation. Cdr1, Snq2, and Yhd3 (ABC transporter protein) and Rdc3 and Mdr1 (major facilitator protein) are upregulated during mature bio­lm. C. auris synthesized a lower amount of Als protein (Als1 and Als5) as com- pared to C. albicans which is required for adhesion (Kean etal. 2018a).
C. auris can form biolm on surfaces for longer time periods and are tough to
eradicate. Biolm helps to protect this organism from antifungal drugs like azoles, polyenes, and echinocandins. During biolm formation expression some of known adhesin genes such as IFF4, CSA1, PGA26, HYR3, PGA52, PGA7, and ALS5, etc., are induced. In addition, the formation of biolm is accompanied by upregulation of efux pumps (CDR and MDR), which makes biolm less susceptible to the drug (Watkins etal. 2022).
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10.3 Biofilm

A group of microbial cells enclosed in an extracellular matrix, known as biolms, can grow on both biotic as well as abiotic surfaces (Nobile and Johnson 2015). Generally, microorganisms prefer to grow in the biolm form. Biolm can form on human surfaces or on an indwelled medical device (Hall-Stoodley etal. 2004). Initial studies suggested that biolms formed by C. auris are weaker that C. albi- cans biolms (Oh etal. 2011). C. auris biolms possess relatively high antifungal drug resistance in comparison to others. In C. auris, the ability of forming biolm varies from clades to clades. C. auris can form biolms from both aggregated as well as non-aggregated cell types. Transcriptomics-based studies have unveiled the crucial role of gene encoding adhesin, transporter pumps, etc., in the development of biolm. Essentially the C. auris biolms are less explored till date (Du etal.
2020; Kean etal. 2018b).
10.4 Development ofBiofilm andTheir
Molecular Mechanism
Biolm formation involves the role of various differentially expressed transcripts (Fig.10.1). Basically, biolm formation can be divided into four stages.

10.5 Adherence

The initial adhesion phase of surface colonization is necessary for the start of bio­lm formation. Several GPI-linked cell wall proteins are highly expressed during the initial phase of biolm formation, suggesting that these proteins were involved in the initial adhesion phase. Earlier studies have shown that C. albicans IFF4 and CSA1 are involved in cell-cell cohesion and adherence to abiotic and mucosal sub­strates (Table10.1). The function of IFF4in mediating cell-cell contact was postu­lated by Fox et al.’s transcriptional studies, which revealed that it is a cluster adhesion transcripts which are activated throughout the process of biolm forma­tion. It is noteworthy that a null mutant of iff4Δ exhibited reduced virulence and decreased adhesion during the initial stage of biolm formation. Taken as a whole, both studies demonstrate how important it is for biolm development. Agglutinin­like sequence (ALS) protein members are important to Candida albicans adher­ence, primarily through ALS3. Interestingly, several members of the ALS family are missing in C. auris. C. auris has two orthologs of ALS1 and ALS5 which are upreg­ulated in mature biolm.
Adhesion plays a crucial role in host surface interaction along with the formation
of multicellular aggregations. The Als proteins are big glycoproteins present on the outer cell surface of pathogenic Candida that are essential for adhesion to abiotic and host surfaces, aggregative behaviour, and the formation of biolms. Unlike C. albicans, which primarily colonizes gastrointestinal and genitourinary tracts,
10 Dissemination ofCandida auris Biolms: AMedical Abrosia
Fig. 10.1 Developmental stages of Candida auris biolm formation
Table 10.1 Biolm-related genes in Candida auris
S.
Function Gene identier
no. 1 Adhesion IFF4, PGA26, PGA52, CSA1, PGA7,
2 Biolm
formation/ maturation
3 Extracellular
matrix
HYR3, ALS5 TRY4, TRY5, ALS4, PGA1, SAP9, SNF2, BRG1, MP65, AHR1, ASC1
CEK1, TPK2, GAM1, SUR7, ADH2, EPD1, CBK1, ILS1, RPS4A, RIX7, At2g, ARO1, STH1, FAS2, PMA1, CPH1, ZPR1, DUS3, CZF1, SIM1
KRE6, EXG, SAP5, PLB3 Khari etal. (2023),
265
References Khari etal. (2023),
Kean etal. (2018a), Zhou etal. (2021)
Khari etal. (2023), Zhou etal. (2021)
Kean etal. (2018a)
C. auris largely colonizes the skin (Fox etal. 2015; Nobile et al. 2012; Muñoz etal. 2018).

10.6 Maturation

In this stage, cells keep dividing and begin interacting with one another through a process called quorum sensing. As a result, a sizable, clumped cell structure is cre­ated which is surrounded by an extracellular matrix primarily made of proteins and polysaccharides (Nobile et al. 2012; Muñoz et al. 2018; Ramage et al. 2002; Schweizer etal. 2000). The technique quorum sensing (QS) uses the quantity of microorganisms in a population as a basis for gene expression detection and control. To form biolms, pathogens utilize the QS mechanism.
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10.7 Quorum Sensing inC. auris
Farnesol is a well-studied quorum-sensing molecule with a potent role in the patho­genesis of C. auris. It can serve as an adjuvant and/or antifungal to inhibit the drug resistance Candida sp. that may offer a promising substitute for treating Candida species such as C. auris. Farnesol stimulates reverse morphogenesis and inhibits the morphogenetic switching of C. albicans. In addition to C. albicans, it also signi­cantly inhibits non-albicans species and moulds. Treatment with farnesol reduced biolm-forming capacity in a concentration-dependent way, but it had no effect on biolm growth after a day. It greatly decreased the growth rate of C. auris but had no effect on the planktonic C. albicans growth rate (Nagy etal. 2020a). Farnesol­treated C. auris cells affect the expression of efux transporters (Jakab etal. 2021). Farnesol has no effect on the synthesis of phospholipase in C. auris, in contrast to
C. albicans where it did (Fernandes et al. 2016). Exposure to farnesol caused C. auris to produce signicantly more reactive species, suggesting no role of farne- sol in shielding C. auris from oxidative stress. Farnesol thus has distinct effects on C. auris biolm formation. According to recent research, farnesol inuences the
synthesis of ergosterol by differential regulation of ergosterol biosynthetic genes (Yu etal. 2012; Nagy etal. 2020b). The inhibitory fungal activity of echinocandins and uconazole is notably increased by farnesol in a synergistic manner. When there are enough cells in a system, such as when Saccharomyces sp. and Candida albicans produce aromatic alcohols, the signal that causes the system to accumulate and induce biolm formation is one of the key signals for biolm induction (Hogan
2006). Both nitrogen deprivation and neutral alkaline pH are indicators of the onset
of biolm formation. The formation of pseudohyphae in fungi such as Saccharomyces is indicated by a cascade of aromatic alcohols, also known as fusel alcohol. Low concentration of nitrogen induces the formation of aromatic alcohols while high concentration of ammonia limits its formation. Ehrlich’s fusel alcohol formation is the process through which alcohol dehydrogenases transform aromatic amino acids that are produced or absorbed into aromatic alcohol. One of the several pathways that lead to the formation of biolms, the RIM101 pathway, reacts to pH.The two GPCRs that make up the RIM pathway, RIM9 and RIM21, sense changes in pH in the surrounding solution and use that information to hyperphosphorylate the protein RIM8. Essentially, it is a protein that resembles beta-arrestin and triggers the RIM 13 protease. It cleaves and induces transcription activator RIM101. Aro8p and Aro9p transaminases are produced when the RIM101 transcription factor is acti­vated (Ehrlich 2006; Dai etal. 2021; Parsons etal. 2004; Cornet and Gaillardin
2014; Garnaud etal. 2018; Ghosh etal. 2008). These are necessary to produce the
aromatic alcohols that cause the formation of biolms. Tyrosol functions as a quo­rum QSM in Candida albicans, while the aromatic alcohols phenylethanol and tryp­tophol do the same in Saccharomyces (Alem etal. 2006; Chen et al. 2004). The main glycoprotein on the cell surface of Saccharomyces, Flo11p, acts as a QS path- way sensor. Additionally, RIM101 controls the expression of several calcium trans­porters, which in turn regulates the activity of Crz1p via the calcineurin pathway. This pathway may be in charge of polysaccharide modication proteins, cell wall
10 Dissemination ofCandida auris Biolms: AMedical Abrosia
adhesion, and azole resistance, among other things (Yan etal. 2020; Li etal. 2021a; Edlind etal. 2002; Miyazaki etal. 2010; Yu etal. 2015; Wang etal. 2011; Xu etal.
2020; Song etal. 2020; Khari etal. 2023).
267

10.8 Dispersion

This is the last step of C. auris biolm lifecycle. This phase involves the bursting out of above formed enclosed compact structure known to be biolm. In dispersion phase, matured biolm ruptures to cells to start a new cycle of biolm and free to cause bloodstream infection in an immunosuppressed person (Kean etal. 2018a). The factors that trigger dispersion are largely unknown.
10.9 Composition andFunction oftheExtracellular Matrix
Extracellular matrix of biolm is mainly made up of mannan and glucan which play a pharmacological role in biolm drug resistance by hydrolysing individual poly­saccharides (Mitchell etal. 2015). Treatment of biolm with mannosidase and glu­canase to disrupt matrix which will increase uconazole susceptibility. These ndings are consistent with the description of other Candida species (Dominguez etal. 2019).
10.10 Models inBiofilm Study
A number of models performed that mimic the real in which pathogens produce biolm have been developed in order to better understand the ner points of biolm.
Vascular catheter model—The development of C. auris biolms is studied in
rats, mice, pigs, and other vertebrates. Mice are less expensive than other animals, which is an advantage of using them. However, performing surgical procedures is more difcult due to the diameter of the vessels. Vascular catheter models are among the most popular tools for evaluating invivo biolm formation. Originally designed to investigate the pathogenesis linked to Candida albicans biolm, the catheter is placed in the jugular vein, tunnelled beneath the skin, and protected by a wire casing (Khari etal. 2023).
Skin models—In hospitals where outbreaks are possible, C. auris is thought to
spread due to its ability to effectively colonize the skin’s surface. Therefore, culti­vating C. auris under conditions that most closely resemble the clinical setting can help gain a better knowledge of C. auris infection (Horton etal. 2020; Johnson etal.
2022; Corzo-León etal. 2022). However, research has shown that C. auris biolm
formation is more prominent in the skin. The management of breakout and the avoidance of invasive diseases actually depends on our ability to comprehend the exact mechanism underlying skin colonization and to pinpoint strategies to impede this process (Khari etal. 2023).
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G. Gangwar et al.
Skin mimics—C. auris can live and multiply on the skin, a special type of media
which mimics skin sweat has been analysed. In synthetic sweat medium, C. auris was shown to induce C. albicans biolm formation tenfold. Seven days after desic­cation, the burden of C. auris was 30 times more compared to C. albicans. After desiccation, C. auris biolms grew readily, whereas C. albicans was not viable at 14 days (Horton etal. 2020). All things considered, these results demonstrated that biolms produced by C. auris can withstand desiccation and evaporative sweat dry­ing prominent in the skin. As C. auris grows in a synthetic sweat medium, it pro­duces a multilayer biolm composed entirely of yeast cells. On the other hand, Candida albicans generated a thin biolm consisting of yeast cells and irregular hyphae or pseudohyphae. Contrary to what was seen in the RPMI medium, C. auris biolms were denser compared to C. albicans in the skin mimic medium (Khari etal. 2023; Abe etal. 2020).
Porcine skin exvivo model—This model involves pig skin which is a close
mimic of human skin in terms of thickness, distribution of cells, and process of repair (Mitchell etal. 2013; Larkin etal. 2017; Donlan 2001). It is possible to use skin from biopsy samples taken for a variety of purposes or from animals sacriced for a variety of reasons. Initially, the skin samples are cleaned hairs removed and the samples are cut into the proper sizes followed by incubation in semi-solid tissue culture media. Parafn is applied to the epidermal surface as a barrier. To investigate biolms, C. auris cells that have grown properly are quantied and then inoculated onto skin samples that have been prepared (Khari et al. 2023; Corzo-León etal. 2022).
Human skin exvivo model—The best model for comprehending the formation
of C. auris biolms and its pathogenesis in human skin. The development of a human skin model with and without an implanted catheter has proven successful in studying the formation of C. auris biolms. Samples of healthy human skin taken from abdominal or breast surgeries, for example, can be used for various purposes. Following a precise cutting and washing process, the tissue skin samples were mixed with x concentration of C. auris cells at a xed concentration. The growth of Candida auris was observed under three distinct conditions: (a) unwounded, (b) wounded, and (c) catheterized. In order to prevent deep penetration, the sample is repeatedly pricked with the needle to create the wounded samples. A measured amount of developing C. auris cells are injected into the epidermis of both unwounded control subjects and wounded test subjects. Subsequently, the skin tis­sue is permeated with an appropriate-sized catheter onto the epidermis at one edge in order to analyse the effect of the catheter. Fungal cells are applied via a different skin edge (Khari etal. 2023; Corzo-León etal. 2022).

10.11 Animal Models

Guinea pig skin model—Pig skin is preferred for studying the pathophysiology of
C. auris due to its striking similarity to human skin. Prednisolone is administered to animals to cause local immunosuppression in the aficted skin area. A designated,
10 Dissemination ofCandida auris Biolms: AMedical Abrosia
269
cleaned, and hair-free area is chosen and situated behind the guinea pig. To make a cut without causing bleeding, the skin is gently incised with sterile sandpaper. Over the chosen area, growing C. auris cells are suspended. On the other hand, no fungal development was seen when imaging pig skins infected with Candida albicans. Multiple-layered aggregates were not observed (Khari et al. 2023; Horton etal. 2020).
Skin colonization and decolonization mouse model—The process of coloniz-
ing the skin involves injecting the mouse’s back skin and pinna. It takes four doses of the vaccine to guarantee colonization in the mice. Following the establishment of skin colonization on day 7, test compounds are applied once daily for 7 days to observe any occurrences of decolonization (Khari etal. 2023; Herrada etal. 2022).
Other models for C. auris pathogenesis—About 30 studies have examined the
pathogenicity of Candida auris using invivo models; the most widely used models are murine ones. Mammalian models are more costly, require more labour, and take longer. Using an immune-suppressed mouse model, it was found that invasive C. auris strains produce more biolm than non-invasive strains (Abe etal. 2020). Yet, because using invertebrate models of candidiasis raises ethical and nancial questions, alternative systems are being promoted. Based on different invertebrate models such as Caenorhabditis elegans, Galleria mellonella, etc., the pathogenesis of C. auris infection has been extensively studied. It has less ethical issues. Several routes, including skin surface, injection, and food ingestion, can be used to demon­strate the virulence mechanism of a given pathogen. The study of bloodstream fun­gal infection is done through haemolymph inoculation. Galleria mellonella is another well-liked invertebrate model that is smaller, permits multiple inoculations, has a dened dosage, and grows at 37°C, which is its physiological temperature. The immune response induced by WT larvae is similar to that of mammals and is susceptible to fungal infection. Previous studies looked at the in vitro biolm­forming, haemolytic, and enzymatic activity of a number of C. auris isolates. Invertebrate model hosts, G. mellonella and C. elegans, were used to analyse the virulence properties of these isolates. Notwithstanding the fact that C. auris did not produce hyphae in the G. mellonella model of candidiasis, these nonaggregating isolates of the pathogen were discovered to be more virulent than certain isolates of C. albicans. It was demonstrated that C. auris isolates, both aggregative and non­aggregative, are capable of killing both model organisms. After 120h, at least 47.7% of the G. mellonella and C. elegans species could be killed by any of the employed C. auris strains. The G. mellonella and C. elegans models of candidiasis are both straightforward and appropriate for assessing the pathogenicity of C. auris. G. mel- lonella, the model host, the microbes can be injected more accurately into host tis­sues (Khari etal. 2023; Arias etal. 2020).
Gelatin promotes C. auris biolm formation—The pathogenicity and drug tol-
erance of Candida auris are signicantly inuenced by biolm. The heterogenous substrate-dependent biolm formations are reported. Thereby recently Biswas etal. devised an invitro culture technique for culturing of C. auris on gelatin-coated coverslip. Primarily it was based on the understanding that the fungus effectively colonizes skin and that gelatin resembles the architecture of skin. The most
270
prevalent protein in the body, collagen serves as the foundation for many tissue formations and is a good substrate for adhesion. Gelatin, a hydrolysed version of collagen, functions as an adherent mesh and could be a useful dietary source. Gelatin closely resembles the host’s invivo system and is a less expensive alterna­tive to Thermanox coverslips. The method includes lower handling errors and uses microscopy for the measurement of biolm. The gelatin-coated coverslip is placed in a 6-well plate and the biolms are cultivated with RPMI 1640 as media. Biswas etal. used scanning electron microscopy to image the biolms in order to assess their architecture and cellular morphology. Compared to Thermanox coverslip sur­faces, high-burden biolms were observed on gelatin-coated coverslips. The biolm was made of yeast cells surrounded by an EPS layer. A very less abundant C. auris biolm was formed on the Thermanox coverslip (Biswas etal. 2023a).
G. Gangwar et al.
10.12 Role ofRas/cAMP/PKA Signalling Pathway inC. auris
Biofilm Formation
For fungal pathogenesis, biolm formation is an essential part of virulence because it offers tolerance to antifungal drugs and environmental stresses. Planktonic cell adhesion to surfaces, maturation, and cell dispersal to form new biolms are the steps in the biolm formation process. Prior studies have demonstrated that loss of BCY1 gene results in induced biolm formation while the loss of both TPK1 and TPK2 genes reduces the formation of biolm. It was discovered that, in comparison to the wild type, pde1Δ and pde2Δ had greater capacity to form biolms. This emphasises on the role of Ras/cAMP/PKA signalling on biolm formation in C. auris. Further expression analysis of cell adhesin genes showed and induced expression of ALS4in the mutant of BCY1, IRA2, and PDE2. Moreover, the expres­sion of PGA7 and SIT1 was substantially enhanced in the mutant of IRA2, PDE2, and PDE1PDE2.
A comparative analysis of Pde1Δ and Pde2Δ revealed an antagonistic effect
between the two, with Pde1Δ expressing comparatively less than pde2Δ. This was due to the consistent increases in ALS4, SIT1, and PGA7 expression levels in pde2Δ, but only an insignicant increase in pde1Δ. Nevertheless, pde2Δ had higher expression levels of PGA26 and SAP6, two negative regulators, which may account for the mutant’s reduced ability to form biolm in comparison to pde1Δ, pde2Δ, and other mutants. The above results conrmed that the Ras/cAMP/PKA pathway leads to promote adhesion which is needed for biolm. An exposure of C. auris to PDE2 inhibitor EHNA [erythro-9-(2-hydroxy-3-nonyl)adenine] demonstrated 60% enhanced expression of PDE2. After receiving EHNA, PDE2 expression rose by 60%, suggesting that the inhibitor was having a compensatory effect. Genes involved in cell adhesion also showed altered expression levels; in comparison to the untreated wild-type group, the positive regulator ALS4 increased approximately tenfold, and PGA7 increased approximately fourfold. On the other hand, PGA26 did not exhibit a statistically signicant difference, and SAP6, the negative regulator, increased by about 1.4-fold. SIT1 did not exhibit a signicant difference. The ndings imply that
10 Dissemination ofCandida auris Biolms: AMedical Abrosia
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C. auris can enhance biolm formation by hyperactivating the Ras/cAMP/PKA pathway, which in turn can raise the expression levels of several genes linked to biolm formation. Previous research has shown that deletion of PDEs in C. albicans results in decreased glycogen accumulation, a decreased ability to survive in nutri­ent-starved environments, and a diminished ability to cause disease. In A. avus, a similar nding was also made. Nutrient scarcity in the mammalian host environ­ment impacts a pathogen’s ability to accumulate glycogen as a carbon source and thus its competitive tness. Furthermore, there was a signicant reduction in the thermotolerance of the bcy1Δ, pde2Δ, and pde1Δ pde2Δ mutants, which could potentially lessen their virulence. This could potentially increase the virulence of C. auris, as the cells within the biolm may be more resilient to the host immune system. Thus, the less noticeable virulence attenuation in pde2Δ and pde1Δ pde2Δ mutants may result from these compounding effects caused by activation of the Ras/ cAMP/PKA pathway (Kim etal. 2023).
10.13 Role ofTOR inC. auris Biofilm
Under nitrogen deciency, TOR protein promotes the formation of biolm. RHB1 is sensed through Candida albicans which is an indication of biolm formation. Mep2 permease and Npr1 kinase circuitry are used for the sensing (Neuhäuser etal.
2011; Rutherford etal. 2019). TorC1 regulates different functions such as cell wall
regulator protein BCR1, hyphal growth gene Efg1, and expression adhesion gene SFP1. Additionally, Brg1 expression is blocked by recruiting transcriptional repres­sors such as NRG1 and TUP1 (Chen and Lan 2015). The transcription factor Brg1 is expressed when TOR is inhibited, altering the promoters of hyphal genes (Flanagan etal. 2017). Additionally, TOR phosphorylates RPS6 to signal ribosome starvation, which inhibits the anabolic process and initiates the synthesis of stress­related proteins. This may have an impact on the C. auris stress-related gene transla­tion triggering (Chowdhury and Köhler 2015). C. auris produces less biolm when TOR is inhibited during the early and intermediate stages of biolm formation (Biswas et al. 2023b). According to transcriptome studies, adhesion genes are mostly expressed in the early and intermediate phases of biolm formation (Kean etal. 2018a). Therefore, C. auris seems to share the same function for Tor in cell adhesion and biolm formation. For complete understanding, it is necessary to investigate the associated TOR molecules. Interestingly, based on the protein simi­larity index between Candida albicans and Candida auris, conserved proteins such as GPCR Rhb1 (78.02%), Npr1 (61.74%), Vam6 (40.26%), and the central TOR molecule (77.03%) are found (Biswas etal. 2023a).
In the presence of Tor inhibitors rapamycin and torin2, the biolm formation was
measured. Regardless of when it was added, rapamycin reduced the growth of bio­lm by 1.4-fold. After 4, 8, and 12h, respectively, torin2 inhibited the formation of biolm by 1.8-, 1.7-, and 1.2-fold. When cells treated with torin2 were exposed to biolm formation for 12 h, the degree of inhibition was marginally decreased. Therefore, even in biolms, inhibition of Tor causes a reduction in cell growth. The